Experimental confirmation of effectiveness of fenestration in acute aorticdissection

Background. Aortic fenestration is used clinically to treat organ ischemia in acute descending aortic dissection. However, fenestration has not been s tudied experimentally. This study does so using an animal model. Methods. Descending aortic dissection was created in six dogs, with subsequ ent fenestration of the infrarenal aorta. Blood flow (femoral, cephalic, an d renal), blood pressure (femoral and carotid), and aortic distensibility w ere measured at baseline, after dissection, and after fenestration. Values were compared using paired t tests. Results. Baseline femoral, cephalic, and renal arterial Bows were 53 +/- 37 , 78 +/- 65, and 83 +/- 52 mL/min, respectively. Baseline femoral and carot id pressures were 82 +/- 13 and 81 +/- 11 mm Hg, respectively. After dissec tion, femoral, cephalic, and renal arterial now decreased to 20 +/- 21 (p < 0.05), 38 +/- 26, and 56 +/- 36 mL/min, respectively. Femoral blood pressu re decreased to 28 +/- 17 mm Hg (p < 0.05). With fenestration, femoral, cep halic, and renal flows increased to 60 +/- 37 (p < 0.05), 78 +/- 51, and 80 +/- 48 mL/min, respectively. Femoral blood pressure increased to 85 +/- 28 mm Hg (p < 0.05). Carotid pressure remained unchanged with dissection and fenestration (77 +/- 17 mm Hg, 82 +/- 17 mm Hg, respectively). Baseline aor tic distensibility (21%) decreased significantly after dissection (to 1.4%, p < 0.05) and increased after fenestration (to 12%, p < 0.05). Conclusions. Experimental aortic fenestration restored blood pressure and B ow to hypoperfused organs in acute descending aortic dissection. The contin ued clinical application of fenestration is supported. (C) 1998 by The Soci ety of Thoracic Surgeons.